I have a chronic anal fissure for 4 months now. I have been using diltiazem cream but its not working - still having the same pain and spasms.
My doctor has told me the next step is botox injections to relax the sphincter muscle. I have BIG concerns and questions though if anyone can please help. Does it always cause temporary incontinence? If so, for how long, and is it just (noisy?) gas - or worse? Also, how does it feel - is the area numb - can you still feel sensations down there when you have a BM? im imagining a total lack of feeling and an anesthetized sensation. As much details as possible would be helpful to make my decision about whether to go for it as i'm pretty nervous.

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03-12-2010, 06:52 AM

#2

Silas1067

Junior Member

(male)

Join Date: Feb 2010

Posts: 15

Re: Botox for anal fissure - does it cause incontinence?

I had the same thing--but didn't do botox.

The problem is that scar tissue builds up around the fissure and prevents proper healing.

I had the LIS surgery (took 10 minutes in outpatient) and it totally corrected the problem. I didn't have any issues with incontinence (those fears are overblown).

If you are having a lot of problems, I recommend going in for the procedure--my fissure got so bad I was in serious pain 24/7.

03-21-2010, 01:40 PM

#3

Neonsky

Junior Member

(female)

Join Date: Jun 2009

Posts: 14

Re: Botox for anal fissure - does it cause incontinence?

Quote:

Originally Posted by Silas1067

I had the same thing--but didn't do botox.

The problem is that scar tissue builds up around the fissure and prevents proper healing.

I had the LIS surgery (took 10 minutes in outpatient) and it totally corrected the problem. I didn't have any issues with incontinence (those fears are overblown).

If you are having a lot of problems, I recommend going in for the procedure--my fissure got so bad I was in serious pain 24/7.

Thanks Silas - that's useful info, and I'm very glad to hear it was successful for you.
Right now dialtezem cream is stopping the pain almost completely, but if i stop using it for even one day then the pain is back. So i know this means the fissure hasn't healed in any way. I dont understand why. Cuts heal don't they?? Why is this different? its been six months now.
Has anyone had experience with botox - and can tell me about possible incontinence/gas incontinence after effects? i'm so worried about this - i work in an office, and have bad gas anyway so this would be unbelievably humiliating and i would rather stay with the fissure pain than go through that. What is wind incontinence like anyway? Is it still noisy farts or is your sphincter so 'loose' its quiet? (sorry if this is too graphic!)

04-18-2010, 06:59 PM

#4

NCgirl4342

Newbie

(female)

Join Date: Apr 2010

Posts: 1

Re: Botox for anal fissure - does it cause incontinence?

Hi there,
I had the Botox procedure done about 5 weeks ago and I do experience some mild gas incontinence but nothing major. Its only occasionally and it has not embarrassed me. I also work in an office and was worried about it but the pain of the fissure in my opinion was worse than a little gas! My pain definitely lessened after the procedure. The bad news is it hasnt healed yet but Im glad I did it. Good luck!

04-19-2010, 12:02 PM

#5

YorkPDF

Junior Member

(male)

Join Date: Apr 2010

Posts: 43

Re: Botox for anal fissure - does it cause incontinence?

Neonsky,

My guess is you are experiencing the same problems I'm having. I keep re-tearing or opening my fissure after every BM. My muscles go into a spasm and cause extreme pain. Like Silas was, I'm in pain 24/7 so I'm scheduled to have my LIS surgery this Fri. At this point, I'm willing to deal with incontience over the pain. I haven't been able to leave the house in 13 days in counting because as soon as I have a BM, I'm in so much pain that I can move. I've been soaking in hot water for the last 5 days at a minimum of 6 hrs a day. I'm at my breaking point. I called my surgeon today and offered to pay anyone $300 if they would switch their surgery with me so I can get in before Fri.

I've tried every cream they can give you and nothing is taking away the pain. I have no interest in Botox because my issue is the spasms and the only fix for that is LIS. I wish you all the luck in the world and hope the Botox works if that is the direction you go. I will be posting updates after my surgery this Fri. I just hope I can make it that long

04-19-2010, 05:37 PM

#6

luckycharms

Member

(female)

Join Date: Jul 2009

Location: USA

Posts: 62

Re: Botox for anal fissure - does it cause incontinence?

I had botox into the rectal muscle and I had no incontinence whatsoever of gas or stool....I had this injection due to anismus though, not an anal fissure. I did have numbness down there for 3 days! It was not painful, just felt weird. Are you being put to sleep for the injection? I was put to sleep for mine.

York, I did have an anal fissure like you. The pain was almost unbearable. After a bm, I would be in severe pain and would just sob for hours. That was the most pain I had ever felt in my life. The surgery worked and I am now 100% fissure and pain free....BUT, the pain after surgery was pretty severe too. Be ready for the pain after surgery. Take your pain pills on time and don't skip doses. Buy yourself some miralax or stool softeners to be sure you don't get constipated. Pain pills are very constipating, that is why I recommend miralax because it forces water into the colon.

04-20-2010, 12:48 AM

#7

Neonsky

Junior Member

(female)

Join Date: Jun 2009

Posts: 14

Re: Botox for anal fissure - does it cause incontinence?

Quote:

Originally Posted by YorkPDF

Neonsky,

My guess is you are experiencing the same problems I'm having. I keep re-tearing or opening my fissure after every BM. My muscles go into a spasm and cause extreme pain. Like Silas was, I'm in pain 24/7 so I'm scheduled to have my LIS surgery this Fri. At this point, I'm willing to deal with incontience over the pain. I haven't been able to leave the house in 13 days in counting because as soon as I have a BM, I'm in so much pain that I can move. I've been soaking in hot water for the last 5 days at a minimum of 6 hrs a day. I'm at my breaking point.

You poor poor thing. Mine isnt nearly that bad. I guess i am atypical as i dont even have pain with a BM in the morning - the pain is just there all day, and is worse in the evenings. Right now, if i use the diltiazem cream, my pain is minimal, its just cant sit down comfortably - but not tearing pain. I really can understand that you just want to go fro the surgery - how long have you had it? has it got worse or stayed the same over time?

Lucky charms - that reassures me that you had no incontinence after botox. i think they dont put you to sleep here for the injections - its a quick in and out thing i believe. Did you have the lis surgery too like YorkPDF is going to have? How are you doing now?

NCgirl4342 - This is what I'm scared of! i think its because (ahem) i am a rather gassy person. Actually VERY gassy! How 'occasional' is it? Once a day, once a week, 5 times a day? Poor you. And you have this occasional gas incontinence even 5 weeks after the injections? How did the procedure feel - were you asleep? Didi the fissure pain go straight away or did it take time? Any details (gruesome or otherwise) gratefully received!

I am awaiting delivery of a so called 'miracle oil' from Amoils - im a bit concerned its just web hype but i am desperate so i ordered it. maybe im dumb - just the type of sucker that will try anything as a last resort!

Last edited by Neonsky; 04-20-2010 at 12:49 AM.

04-20-2010, 11:40 AM

#8

YorkPDF

Junior Member

(male)

Join Date: Apr 2010

Posts: 43

Re: Botox for anal fissure - does it cause incontinence?

My pain has been going on since 3/25/2010 at 4 pm. I've read everything I can about fissures and healing and based on my experience, I don't really have an option. I'm hoping this thing will heal before I have to look at a fissurectomy. They said I don't have scar tissue built up yet but the fissure is chronic. I've spoken with my wife and I told her that I can't live the rest of my life wondering if the next BM is going to be the one that re-tears the fissure. I know that the fissure can re-occur after the surgery but I feel that I will be able to manage that by my diet and fiber intake. I also take Colace twice a day to help.

LuckCharms, can you expand on the pain aspect after the surgery? Is it as bad as before the surgery and how long did it take before you finally felt a little relief? I honestly can't imagine the pain after the surgery being as bad as before the surgery but I guess if that is what happens, so be it. Sounds like a no win situation for me

I will definitely continue the Colace. Do you think I should switch to Miralax after the surgery? Does it work better than Colace? My only experience with Miralax is preparation for a colonoscopy. Hopefully this isn't a graphic question but did you try to make your stool as "watery" as possible? I have read where you don't want "diarrhea" when you have a fissure.

I guess I'm glad I heard about the pain before my surgery because I think I would have been even more depressed if I felt the same pain after the surgery. I'm hoping it doesn't last for very long.

Any insight you can provide would be greatly appreciated. As I've mentioned many times before, I've already hit my breaking point multiple times and I just want to get past this experience so I can move on with my life

04-20-2010, 05:58 PM

#9

k1w1NZ

Junior Member

(female)

Join Date: Nov 2009

Location: Auckland

Posts: 10

Re: Botox for anal fissure - does it cause incontinence?

Hi There,

I had my second fissurectomy and second round of Botox three weeks ago. This time around I have not noticed much trouble at all with any gas incontinence. I found the first time around if I was walking or moving it would be hardest to control any gas. Luckily the few times it creeped up on me I was in a noisy place so nobody would have even have known. Another thing I have noticed, any lack of control of gas with Botox seems to come out quietly and softly. You would hopefully not be sitting in a meeting and have a huge 'noise' come out! Having said that, everyone is different and I dreaded (and still do) any meetings at work because of it! The best thing to do is if you do have fissurectomy and/or Botox is eat a simple, easily digestible diet afterwards and I mean SIMPLE. I learnt that the hard way really. Stay away from anything that could bring on gas or make going for a BM harder. From my experience of already having had a fissurectomy before and from excellent boards like this one, a fissurectomy is a slow healing and painful procedure BUT the fact that is poses no threat to your continence makes it worthwhile to go for Botox/Fissurectomy first. If you DO experience incontinence of gas, it will NOT be permanent.
Statistically, I should heal once and for all this time around however I am still doing every conceivable thing to help this happen - and having patience is the biggest thing right now!!! Good Luck to anybody dealing with any kind of fissure pain - things can only get better.

04-20-2010, 07:18 PM

#10

luckycharms

Member

(female)

Join Date: Jul 2009

Location: USA

Posts: 62

Re: Botox for anal fissure - does it cause incontinence?

York, I had severe, agonizing pain off and on for 2 years before I had surgery. I was so embarrassed to go to the doctor, but, the pain became chronic and I started having it everyday. I then went to a general surgeon. He recommended having the spincter muscle clipped and I said sure and had that done. It did not help with the pain at all. So, I then went to a colorectal surgeon.

He said the fissure was very deep into the nerves and recommended I have all internal and external hemorrhoids removed and the fissure and all scar tissue removed. So, he went in, scraped out the fissure and sewed the healthy tissue very loosely together and removed all hemorrhoids.

He gave me a nerve block and sent me home outpatient. When we left the hospital I was thinking, I don't feel a thing. Well, 5 hours later, the nerve block wore off and that is when I felt the worst pain of my entire life. I was running around and literally insane with the agonizing pain. I would jump in the tub, jump out, take a pain pill, repeat....

My mother called the doctor and he called in a different rx for pain. This did not help and my mom took me to the ER. The ER doctor gave me several shots for pain and yet my body still shook uncontrollably because the pain was so intense. The pain was a 12 on a scale of 1 to 10. The ER doctor finally hooked me up to a morphine pain pump and gave me something to knock me out.

They inserted a catheter for urine and I slept for 24 hours from all the drugs they gave me. This was on a Thursday and I didn't go home until Sunday. I still had not had my 1st bm. I was instructed to set an alarm for reminders to take pain pills.

So, I went home and still had severe pain, but not a 12, more like an 8 or 9. My body still shook from the pain.....I thought burn patients shook because they were cold, NO, they shake because they are in intense pain.

Well, I had to have a bm eventually...and oh, it was bad. The pain was so intense, I jumped off the toilet and into the tub. I would have pain for hours after a bm, even with pain pills. I had severe pain for 3 weeks, then, finally, the pain started getting less and less.

I don't think my case is typical though, I seem to have a very sensitive rectum that spasms when messed with. Do you have hemorrhoids too?

My advice to you is this...
1.)sit on a heating pad...this seems to help with the pain.
2.)take pain pills on time, even if you aren't having much pain at the time...you never know when the dreaded bm will happen and you need some pain pills on board and working before you attempt a bm.
3.)take miralax because pain pills are so constipating.
4.)walk alot when in pain...this seemed to help distract my mind.
5.)drink lots of water
6.)take konsyl fiber everyday to help bulk up the stool. It comes out easier if it is bulked up. Matter of fact, go buy some konsyl fiber tomorrow...it is the best fiber to take...so my GI says anyway.
7.)Do not get diarrhea if at all possible. I can't imagine liquidy poop coming out of a very painful rectum. YIKES

Would I have the surgery again? YES! I wish I would of had it sooner. I think I had so much pain because I let it go on and on and it just got deeper and deeper. I bet your recovery will be much easier seeing as you have not had it for 2 years like I did.

As far as now, if I were you, I would take lots of konsyl fiber to bulk up the stool...if stool softeners are working, then keep taking them. I only suggest miralax if you are taking pain pills...You don't want to be constipated or have diarrhea...find a happy medium.

If you have anymore questions, I will be happy to answer them. I know this sounds scary, but I feel like many people do not know how bad the pain can be.

04-21-2010, 04:45 AM

#11

YorkPDF

Junior Member

(male)

Join Date: Apr 2010

Posts: 43

Re: Botox for anal fissure - does it cause incontinence?

Luckycharms,

Thanks for the information, I think Wow, it sounds like you have been through quite a bit and I'm glad you are feeling better. At this time, the only issue I have is a "chronic" fissure. I don't have hemmoroids or scar tissue. I think we are catching this early enough where the LIS surgery will be all I need to hopefully recover from this fissure. Man, I thought I was dealing with pain. If I had to go through what you did, I'm not sure I would be around to tell my story.

At this point, I'm willing to deal with pain as long as I know I'm getting better. Did I understand you correctly in that you said you had LIS surgery that didn't take so you had to go back for a fissurectomy and another LIS surgery? Finally, do you have any suggestions for what to eat during the recovery process? Did you stick with fruits and vegetables to ensure high fiber intake? I'm trying to find what foods work best. I've been eating beans but have read where you probably don't want a lot of gas during post-op so I'm not sure what to eat. Any guidance or suggestions would be greatly appreciated.

I never thought I would be so afraid of going to the bathroom

04-21-2010, 07:39 AM

#12

luckycharms

Member

(female)

Join Date: Jul 2009

Location: USA

Posts: 62

Re: Botox for anal fissure - does it cause incontinence?

Yes, I had LIS surgery, then went back and had the LIS surgery again with a fissurectomy....

My advice to you when you come home is to eat light and NEVER EVER take your pain meds on an empty stomach. This will surely make you deathly sick with nausea and vomiting, YUCK!

When I had the 1st surgery, the LIS alone, I was fine...I had no surgical pain whatsoever! Now, I am not saying you won't have pain, but it won't be like my 2nd surgery and YES, it was suicide pain...but, I lived through it.

It is good you are getting it taken care of now, before it gets too bad.

And I hope this surgery takes care of that pesky fissure. Please keep me posted as to how you do and I will send prayers your way. Is your surgery scheduled for Friday?

04-21-2010, 02:03 PM

#13

YorkPDF

Junior Member

(male)

Join Date: Apr 2010

Posts: 43

Re: Botox for anal fissure - does it cause incontinence?

Luckycharms,

Yes, my surgery is scheduled for this Fri. at 9:20 am. I called the surgeon's office today to ask a couple questions and I found out I'm known as the patient who tried to bribe the staff. Earlier in the week I was having a bad day so I called and offerred up to $300 to anyone that could get me in sooner. I guess they all got a kick out of it

If you don't mind me asking, was there a reason why the first LIS surgery didn't "work"? I'm not sure how I will respond if this surgery doesn't work. How much time passed before you realized you needed another LIS surgery done? Did they cut the same side or did they do the opposite side? Were there special circumstances that required the second procedure?

I will definitely be posting after my surgery to let everyone know how things are going. Do you remember which foods seemed to be the "easiest" to digest and pass during the recovery?

Just one more full day to go!! Thanks for all of the information you have provided...

04-23-2010, 02:26 PM

#14

littleg

Newbie

(male)

Join Date: Nov 2003

Posts: 2

Re: Botox for anal fissure - does it cause incontinence?

If you have any intention of getting better please read my post. I have suffered from a fissure for 1.5 years. It was suffered from a large hard BM and since then my life drastically changed. I became depressed, stopped eating for fear of going to bathroom, etc. im sure anyone with this problem knows the issues that come with it. I tried everything from diet changes, fiber, stool softener, blood pressure creams, schlerotic injection for hemorrhoids, analpram, and finally two weeks ago Botox. Botox was slightly painful and I had a little leakage after meaning i had to wipe about ten minutes after i first wiped but it was NOTHING to worry about. Botox also wears off. Botox, and this is the most important thing about it, DOES NOT WORK in most cases. It worked for a week with me and then my fissure tore open again. The doctor only suggested I try it as one last ditch effort before surgery. I went in for surgery yesterday and not only am i in no pain at all except for a little sting once in a while, but I went to the bathroom today pain free. As my surgeon said, all his patients ask themselves why the hell they didn't do the surgery sooner, including me. The surgery is a cakewalk and my recovery at least is non remarkable and even enjoyable. I was out shopping an hour after my procedure, albeit i couldnt feel my butt from the numbing injection. Get the surgery. The risk of anything going wrong in the hands of a skilled surgeon is none. If you are in LA I recommend Dr. Gary Hoffman. His team, office, and skill is second to none.

04-23-2010, 04:36 PM

#15

YorkPDF

Junior Member

(male)

Join Date: Apr 2010

Posts: 43

Re: Botox for anal fissure - does it cause incontinence?

Hello, I had my LIS surgery today and so far so good. I was one of the unfortunate ones that had spasms for 6-8 hrs after every BM. I had passed really hard stool on 3/25/2010 and it caused the fissure. My life changed for the worse that afternoon. I haven't been able to leave the house in the last 14 days because I would be in so much pain after a BM. I would have to soak in a tub of hot water multiple times a day for hours and sometimes that didn't work. I tried lidacain (sp?) w/ hydrocortizone and nifredipine (sp?) creams and they did absolutely nothing. I saw my surgeon a week and a half ago and he said that my fissure had become chronic but I would not need a fissurectomy if we I decided to have the LIS surgery now. I decided that I would deal with the incontinence, if it happened, over the pain. I was depressed and had multiplle emotional breakdowns because of the pain. As of the beginning of this week, my BMs were actually ok. However, as soon as I would get up, the spasms would kick in and I would be down and out for the rest of the day.

As far as diet, My NYE's goal this year was to get my weight down from 205 to 175. I hit my goal just before the fissure. Now I weight 162 because I've been afraid to eat because I didn't want to go to the bathroom. My surgeon said I had a "text-book" case and he feels extremely confident the fissure will heal now that I don't have the spasms. Another reason why I went ahead with the surgery is I didn't want the fissure to get deeper and start ripping the muscle fibers.

You really have to decide if the surgery is for you. Some people don't experience the spasms so they are able to heal by the diet change. I was not one of them so I decided to get it done sooner than later. I know there is a chance the fissure can return but I'm willing to take that chance right now.

Whatever you choose, goodluck and as many people will say, make sure you feel comfortable with your surgeon. My surgeon said that he has never had issues with incontinence.

I will post more over the next few days providing updates on my recovery. My surgery was this morning around 10 am. I'm still waiting for my first BM so I won't really know if I'm pain free until then.

Please feel free to ask any questions you might have. I'm not a doctor but I did stay at a Holiday Inn last night